title: Initial perceptions of key stakeholders in Ontario regarding independent prescriptive authority for pharmacists.
abstract: BACKGROUND
  A number of jurisdictions, both in Canada and internationally, have recently expanded pharmacists' scope of practice to allow prescriptive authority.
  
  
  OBJECTIVE
  To ascertain the initial perceptions of the Ontario government and health professional stakeholder groups regarding the prospect of prescriptive authority for pharmacists.
  
  
  METHODS
  Qualitative research methods were used; data sources were policy documents and semi-structured interviews with key informants from the Ontario government and pharmacy and medical professional organizations. Purposive and snowball sampling strategies were used to identify 17 key informants. Fifty-one relevant policy documents were retrieved through searches of organizational websites and interviewee suggestions. Interview transcripts and documents were content analyzed independently by 2 researchers; and once consensus was achieved on key themes, the primary investigator analyzed the remainder.
  
  
  RESULTS
  Pharmacy organizations and Ontario government representatives both expressed support for pharmacist prescriptive authority, suggesting that it would enhance patient access to primary care. Medical organizations were opposed to this expanded pharmacist role, arguing that pharmacists' lack of training and experience in diagnosis and prescribing would endanger patient safety. Other concerns were fragmentation of care and pharmacists' lack of access to patient clinical information. Some government and pharmacy informants felt that pharmacist prescribing would decrease health system costs through substitution of cheaper health professionals for physicians, while others felt that costs would increase due to increased utilization of services. Medical organizations preferred delegated medical authority as the policy alternative to pharmacist prescribing.
  
  
  CONCLUSIONS
  Widely different views were expressed by the Ontario government and pharmacy organizations on the one hand and medical professional organizations on the other hand, regarding the potential impact of pharmacist prescribing on patient safety and access to primary care. This is likely due, at least in part, to the lack of evidence on the expected impact of this expanded pharmacist role. More research is needed to help inform discussions regarding this issue.
authors.affiliation: Health Policy, Ontario Pharmacists' Association, 375 University Ave., Suite 800, Toronto, ON M5G 2J5, Canada. Electronic address: nedzad.pojskic@alum.utoronto.ca.
authors.forename: Nedzad
authors.initials: N
authors.lastname: Pojskic
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, ON M5S 3M2, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: MacKeigan
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, ON M5S 3M2, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Boon
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, ON M5S 3M2, Canada.
authors.forename: Zubin
authors.initials: Z
authors.lastname: Austin
mesh_terms: D011307:Drug Prescriptions; D035082:Federal Government; D006801:Humans; D009864:Ontario; D010465:Perception; D010595:Pharmacists; D024382:Professional Role
keywords: Independent; Pharmacist; Prescribing; Role; Scope of practice; Stakeholder perceptions